Background: Rounds are critical for facilitating patient care, supporting interprofessional communication and providing education for trainees (1,2). Social distancing requirements in the era of COVID led to significant changes to the traditional rounding structure (3). The impact of these changes on patient care, interprofessional communication and education remain unknown.
Methods: An interprofessional needs assessment was distributed to nurses and residents to assess the impact of the pandemic on the rounding experience after the transition from traditional, large-team bedside (“pre-COVID”) rounds to modified, physician-only virtual (“Zoom”) rounds. The University of Chicago Improving GME-Nursing Interprofessional Team Experiences (IGNITE) pediatrics team worked through an iterative process to adjust rounds in response to deficits identified with the needs assessment. The ultimate result was “LEAPFROG” rounds whereby the nurse, attending physician and senior resident meet with the family at each patient’s bedside while interns “leapfrog” to each patient room so as to allow in-person communication while respecting social distancing restrictions. Allied health professionals and other physician team members including non-presenting leapfrogging interns join via Zoom with an iPad and speaker on an IV pole. A follow-up survey was distributed to nurses and residents three months after implementation of “LEAPFROG” rounds. Two-sample t-tests were used to compare “pre-COVID” rounds to “Zoom” rounds and “Zoom” rounds to “LEAPFROG” rounds.
Results: When comparing “pre-COVID” to “Zoom” rounds, residents endorsed significantly decreased satisfaction with educational sessions during rounds (3.8/5 vs 2.2/5, p < 0.01), communication amongst the physician team (4.1/5 vs 3.1/5, p < 0.01) and overall quality of the pediatric hospital medicine rotation (3.9/5 vs 2.7/5, p < 0.01). Nurses and residents endorsed significantly decreased satisfaction with nurse-physician communication (3.4/5 vs 2.3/5, p < 0.01) and medical team-patient/family communication (3.5/5 vs 2.1/5, p < 0.01). When comparing “Zoom” rounds to “LEAPFROG” rounds, nurses endorsed significant improvement in timely knowledge about plan of care (2.6/5 vs 3.1/5, p = 0.02). Residents endorsed significantly increased satisfaction with educational sessions during rounds (2.2/5 vs 2.9/5, p = 0.03), communication amongst the physician team (3.1/5 vs 3.7/5, p = 0.04) and overall quality of the pediatric hospital medicine rotation (2.7/5 vs 4.1/5, p < 0.01). Nurses and residents endorsed significantly increased satisfaction with nurse-physician communication (2.3/5 vs 2.8/5, p = 0.01) and medical team-patient/family communication (2.1/5 vs 2.7/5, p = 0.01).
Conclusions: The initial impact of the COVID-19 pandemic on the traditional rounding structure had negative consequences on interprofessional communication and trainee education. A simple adjustment to rounding structure designed by an interprofessional team can foster improvements in each of these domains while respecting social distancing requirements.